These startups have healing touch

It's the belief that the Indian healthcare sector needs disruptions and the interest of the government that is inspiring many.Anand J, Shalina Pillai&Shilpa Phadnis | TNN | Updated: August 15, 2016, 09:00 IST

It took Leo Mavely almost seven years to sell his first product, Axiostat, a bandage that stops bleeding instantly when pressed to a wound. No one else was making the product in India -his two closest competitors were in the US, but that was precisely the problem. The lack of competition meant potential customers were wary about buying his product. But the 31-year-old biotech graduate knew he was on to a good thing and persisted. "Manufacture and product research and development is a long cycle and one needs to invest a lot," says Mavelly, who founded Axio Biosolutions in 2007.

His startup was incubated at Nirma Labs in Ahmedabad, where Mavely has set up a plant that manufactures two lakh units a year, but he also has an office in Bengaluru where he says the talent pool is larger. Over time, he's built a customer list that includes armed forces, security agencies, hospitals and paramedical care units.

"In the medical industry , you need to get multiple regulatory approvals. Approval from the US and EU authorities is important before you can ship products," says Mavely, who has funding from IDG Ventures and Accel Partners. His kits cost Rs 2,500 to Rs5,000, a fifth of what his US competitors charge. Mavely , who has filed for five patents, is ready to ship across the world.

In India, where thousands lack access to life-saving technology , startups are trying to build devices that are not just cheaper but also more efficient and tailored to India's needs. They're taking on global giants, despite the high cost of development, lack of knowledgeable mentors and relative difficulty of getting funding.

According to data from Tracxn, a startup tracking platform, there are around 120 startups in the medical technology space , which have received $117 million. That comes to about $1 million for every startup, which is small change for device manufacturing firms that have to make high investments in research and development.

Cash crunch

It takes about a decade before a med-tech startup has a product that's ready for the market, and venture capital firms can hope to make an exit. Most VCs, however, are looking to exit after five to seven years, which is why money flows easier to on-de mand or e-commerce startups. Unless the device is nearly ready for the market, entrepreneurs in the medical technology space struggle to raise funding. IDG Ventures, Accel Partners and Norwest Venture Partners are the few active venture capital funds investing in the space.

Mohan Kumar, executive director at Norwest, which has invested in Chennai based medical device-maker Perfint, says, "It is a long time, 10 to 12 years or more, before you can realistically expect returns.Nothing happens in the first five years.That's why most venture funds in India hesitate to put money into the space."

Lack of expertise is another reason why funds are wary of opening up their wallets.As it is still early days, there aren't enough experienced advisers or mentors. At Norwest, decisions to invest in the med-tech space in India are made by the US team as the Indian team does not have the expertise."This is not like software where you can fix things fast. You take one misstep and you lose 18 months," explains Kumar.

Change in the air

"The first biosimilar company I set up did not have takers in 2007, but when we were raising funds in 2013, the investor scene had changed," says Kavitha Iyer Rodrigues, whose company , Theramyt, develops drugs for oncology , arthritis, diabetes and metabolic disorders. Rodrigues is a serial entrepreneur having sold her first startup Inbiopro to Strides Acrolab in 2012, giving her investor Accel four times the returns.

Theramyt, which she co-founded in June 2013, has raised $11.5 million from a group of investors, including Accel and IDG. "It was easier to raise money from a larger pool of investors with good knowledge the second time. People are willing to take larger and longer bets, and are willing to stay for five to 10 years," says Rodrigues, who previously worked at pharma major Biocon. While most of the founders have industry experience, once they are on their own they are pitted against the well-funded startups from the US and Israel, which are often backed by their governments or military .

Going global first

Getting international safety approvals can take years, and there's no domestic revenue till then, as most major hospital chains in India wait for global approvals. India's regulatory authorities are not equipped to certify cutting-edge technology , which puts entrepreneurs at a disadvantage.

"Solid clinical data, publications and early adopters who can vouch for your technology are key before you commercialize.This always takes longer than we anticipate," says Nandakumar Subburaman, founder and CEO of Perfint, which makes robotic devices to deliver cancer drugs directly to organs like the lungs or liver. Since 2005, the company , which holds four US patents, has shipped 100 units, and has been running on $33million in venture funding.

Every pivot or error sets them back months or years. "It is not always possible to have a plan B as we usually focus only on one product," says Subburaman.

Cash crunch

It's the belief that the Indian healthcare sector needs disruptions and the interest of the government that is inspiring many . Cardiologist Charit Bhograj realized it took about six hours to diagnose a heart attack and get the treatment started. "Even in urban India, 75% of clinics do not own echocardiogram machines„" he says. "By the time the patient is sent to a lab, then to another hospital to have the report read, chances of survival dip to 20%," he says.What was needed was a service to read the report and provide diagnosis in minutes.

So, he co-founded Tricog Health in January 2015 to connect ECG devices on the cloud. The moment a report is generated, the information is sent to a team of 16 doctors who send the diagnosis via SMS and a mobile app. Tricog sells its services to small clinics on a pay-per-use model. The ECG machines, which cost around Rs70,000 a piece, are leased to the clinics for a monthly subscription fee of Rs 2,250. Tricog has reached one lakh patients through 300 clinics in Karnataka, Kerala and Delhi.

Reaching remote areas

Another company addressing cardiac care in rural areas is Cardiac Design Labs, which has built a low-cost, wearable cardiac monitor, Mircam, which aids initial diagnosis and sends alerts to doctors. "India has 64 million cardiac patients. About 90% go to smaller hospitals, which don't have the capacity to do diagnostics," says its founder Anand Madanagopal. "We wanted to break barriers in cardiac monitoring through wearable biomedical sensors. I want this product to be deployed across the world and prove India can make high-end devices."

If it's heart disease that some startups are focusing on, Bengaluru-based Forus Health is looking to prevent blindness.Forus' co-founder K Chandrasekhar was inspired by organizations working to prevent blindness and decided to work on the problem in 2010. By 2014, the company had raised Rs50 crore. Its maiden product 3nethra screens for common eye problems that can lead to blindness has over 1,100 installations in 25 countries. It competes with Retcam, considered the gold standard for imaging, manufactured by Clarity Medical Systems, and costs a fourth of what Retcam does.

These first-generation entrepreneurs hope to inspire others to transform healthcare. Support from government, industry and institutions is growing -an example being the Healthcare Technology Innovation Centre at IIT-Madras, an initiative with the department of biotechnology -and several incubators have been set up. A month ago, the government announced its draft regulatory policy for medical devices.

"New startups should benefit from our experience. Making in India is important to establish a domestic med-tech industry ," says Subburaman, adding that this will help them compete in emerging economies.